By Daniel J. Marino, President & CEO, Health Directions
Part 1 of a 3-Part Series
Trustees, CEOs, finance directors and others are increasingly turning to hospital IT leaders with a simple request: Build us the infrastructure for accountable care.
The challenges are many—system options, interface design, staffing, budgets, timelines, etc. One of the biggest problems, however, is that accountable care is pushing CIOs to master new ways of thinking about healthcare IT.
Traditionally, hospital IT decisions are based on department needs, system functionality and cost. CIOs focus on issues like system selection, implementation and ongoing maintenance. Starting now, accountable care is taking the IT decision making process to a new level. To create a viable accountable care infrastructure, CIOs need to understand and weigh factors like industry trends, system interoperability, evolving regulations, organizational strategy and more.
Drawing the interface design scope is not enough. CIOs need to create a design strategy focused on results-oriented information that supports the hospital’s unique accountable care model. The key to moving forward is to understand the fundamental goals of accountable care and how they dovetail with the organization’s overall business strategy.
Basic Drivers and Key Developments
The push for accountable care can be boiled down to three basic drivers.
- The need for cost control. U.S. per capita spending on healthcare is significantly above that of other developed nations, and healthcare economists expect costs to swell as the population ages.
- The demand for better quality. While the U.S. compares favorably to other nations on many quality measures, it appears to lag in important ways, including preventive care and patient safety. Healthcare leaders see a pressing need to improve care processes and outcomes in these and other areas.
- Expanded use of health information technology. Both providers and payers see an opportunity to address cost and quality challenges by taking advantage of health IT to capture more information, increase information sharing, standardize care and improve processes.
These basic drivers are shaping the concept of an accountable care enterprise: a group of providers and provider organizations that use technological tools and clinical integration strategies to assume collective responsibility for the quality and cost of healthcare for a defined group of patients. In turn, this basic concept is being shaped and modified by a handful of key developments.
The first development is payment reform. Experts blame high healthcare costs on fee-for-service reimbursement, the traditional payment system that rewards physicians and hospitals for the number of services performed, with little regard for quality or efficiency. Both government and commercial payers hope that making provider organizations responsible for costs and quality will help cut waste, control spending and improve care. Medicare’s new Value-Based Purchasing (VBP) program is a good example. Under the VBP program, DRG payments are tied to hospital performance on specific quality and patient satisfaction measures.
The second development is the focus on clinical integration. The government is requiring providers that want to function as a Medicare Accountable Care Organization (ACO) to demonstrate that they are collaborating to improve patient care, not just creating negotiation leverage. The key is to show that providers are organizing a clinically integrated delivery system around evidence-based standards, with the consequence that providers who do not achieve these standards are ineligible to share in ACO payments. While clinical integration is a Medicare requirement, the concept applies to all providers who are pursuing any kind of accountable care opportunity.
The third development is the evolution of government Meaningful Use (MU) standards.MU is currently focused on electronic medical record (EMR) reporting requirements and process improvement in the form of chronic disease management and e-prescribing. However, MU requirements will develop toward clinical outcomes improvement, and in the near future accountable care performance goals will merge with MU standards.
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